30). Table 2. Results of the cox proportional hazards model examining hypothesized factors related to urology assessment after TSCI Discussion This study is the first to examine the TSCI patient’s pattern of urologic care. We demonstrated that only 55% of patients saw a urologist within 1 year of their injury, and very click here few patients were referred in subsequent years. This suggests that the momentum for urologic referral is centered on the initial rehabilitation period. This may be because of the frequent contact with the rehabilitation team, and the ease at which patients can discuss bladder-related concerns. It is also likely that many of these

patients had obvious urologic issues which necessitated a urologic referral. Ponatinib mw We conceptualized the process of urologic care for a TSCI patients as follows: (1) the patient is referred to a urologist by a physician; (2) the urologist must accept the referral; (3) the patient must attend the appointment with the urologist; (4) the urologist must offer appropriate investigations and treatment; and (5) the patient must follow through with the recommended investigations and accept the proposed treatments. Any disruption to one of these steps, or a failure to transition from one step to another potentially interrupts the delivery of optimal urologic

care. If patients cannot reliably transition through the steps in this pathway, then clinical practice guidelines on recommended urologic interventions and screening cannot be fully implemented. Efforts need to be focused on potential barriers in the above pathway to ensure the maximal positive impact is realized. While completion of this care partway may ADP ribosylation factor seem straightforward, there are multiple factors that can impede a TSCI patient’s access to medical care.5 Our study addressed the question of how many patients transition through steps 1 to 3 of the above pathway. There are a number of potential reasons why a larger proportion of TSCI do not see a urologist. Firstly, alternative care providers (such as physiatrists) may be taking over the urologic care for some patients. While this is certainly appropriate for many urologic issues, there

are specific investigations (such as cystoscopy) and specific interventions (such as intravesical onabotulinum toxin) that require a urologist. Secondly, due to these patients’ complex urologic issues, not all urologists may accept elective referrals of TSCI. This may hinder physiatrists and general practitioners in their attempts to access urologic care. Indeed, we found that most TSCI patient care was being provided by a small group of urologists, which suggests that a subspecialty interest in this area is likely an important factor for a TSCI patient trying to access urologic care. Thirdly, patients may not attend clinic appointments due their frustrations with the medical system, preference for specialized expertise, and physical accessibility issues.